The Large Uterus Classification System: a prospective observational study

Uccella, Stefano; Kho, Rosanne M.; Garzon, Simone; Casarin, Jvan; Zorzato, Pier Carlo; Ghezzi, Fabio

doi:10.1111/1471-0528.16753

Cited by 7 publications

(7 citation statements)

References 21 publications

(92 reference statements)

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“…Displacement of the adnexal and uterine vascular pedicles by an asymmetrically configured large uterus has been identified by conventional methods of laparoscopic hysterectomy as a potential risk factor for technical difficulties, conversions, and intraoperative surgical complications. 6 Our VLH technique is minimally invasive and can achieve satisfactory outcomes irrespective of the external uterine configuration (Table 3). VLH can also overcome difficulties associated with the conventional laparoscopic technique when exposing and securing the displaced adnexal and uterine vessels.…”

Section: Discussionmentioning

confidence: 96%

“…VLH can also overcome difficulties associated with the conventional laparoscopic technique when exposing and securing the displaced adnexal and uterine vessels. In contrast to a previous study, 6 none of the cases described herein required conversion to laparotomy due to the failure to expose the vascular pedicles or due to uncontrolled intraoperative bleeding, even though we included cases where the uteri were in ≥ 24 weeks-of-gestation, weighed ≥ 1000 g, or contained large fibroids that were ≥ 10 cm in size. 7 The increased upwards mobility of the large uterine mass following the vaginal separation of uterosacral ligaments in these risky cases (Table 3) with a large broad ligament, large cornual fibroids or thick scarring from previous CS, helped us to reduce the technical difficulty, simplified the range of instrument motion, and increased laparoscopic accessibility to the displaced vascular pedicles.…”

Section: Discussionmentioning

confidence: 99%

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A Vagino-Laparoscopic Strategy for Hysterectomy of Large Uteri to Ease Surgical Challenges

Purohit¹,

Sharma²,

Meher³

2023

IJWH

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To develop a vagino-laparoscopic strategy for hysterectomy (VLH) to treat uteri with large fibroids at ≥ 16 weeks of gestation to ease surgical challenges. Patients and Methods: This was an observational study conducted in our private general hospital on 64 consecutive cases involving uteri with large and benign fibroids at ≥ 16 weeks of gestation. We excluded cases with an associated ventro-fixed uterus and large cervical fibroids. Interventions:The VLH strategy involves vaginal separation of the uterosacral with the uterine arteries followed by laparoscopic separation of the remaining upper pedicles. The uterus was then removed vaginally. Results: The largest uteri receiving treatment was at 26 weeks of gestation and the mean uterus weight was 869.60 ± 275.10 g (range: 500-1900 g). The VLH strategy was successful in 63 (98.43%) cases irrespective of the configuration of the uterus. One case (1.56%) required mini-laparotomy conversion due to the need for adhesiolysis; this case exhibited extensive adhesion of the rectum to the posterior wall of the uterus due to a history of previous myomectomy of the posterior wall. There were no conversions due to failed laparoscopic exposure of the adnexal or uterine vascular pedicles, or due to uncontrolled intraoperative bleeding. There were no cases of urinary tract injury or other major complications. The vaginal detachment of uterosacral ligaments before the laparoscopic phase of the VLH strategy increased upwards mobility and dislodged the cervico-isthmic level of large uteri from the narrow lower aspect of the pelvis to the upper wider part of the pelvis; this eased the surgical challenges associated with such cases and avoided complications during laparoscopy. Conclusion:We developed a vagino-laparoscopic strategy for hysterectomy that can ease the technical challenges associated with the majority of large uteri.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

A Vagino-Laparoscopic Strategy for Hysterectomy of Large Uteri to Ease Surgical Challenges

Purohit¹,

Sharma²,

Meher³

2023

IJWH

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“…These ultimately increase the risk of bleeding and require more complex management. Additionally, a larger uterus can compress the neighbouring organs, increasing the rate of unintended damage 9 , 26 , 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have evaluated the difficulties associated with TLH 9 , 11 . However, these studies primarily focused on the incidence of converting to laparotomy, postoperative complications, and readmission rates 12 , 13 .…”

Section: Introductionmentioning

confidence: 99%

Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study

Chen,

jiang,

et al. 2024

International Journal of Surgery

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Background: Total laparoscopic hysterectomy (TLH) is the most commonly performed gynecological surgery. However, the difficulty of the operation varies depending on the patient and surgeon. Subsequently, patient’s outcomes and surgical efficiency are affected. We aimed to develop and validate a pre-operative nomogram to predict the operative difficulty in patients undergoing TLH. Methods: This retrospective study included 663 patients with TLH from XXX Hospital and 102 patients from YYY Hospital in Chongqing, China. A multivariate logistic regression analysis was used to identify the independent predictors of operative difficulty, and a nomogram was constructed. The performance of the nomogram was validated internally and externally. Results: The uterine weight, history of pelvic surgery, presence of adenomyosis, surgeon’s years of practice, and annual hysterectomy volume were identified as significant independent predictors of operative difficulty. The nomogram demonstrated good discrimination in the training dataset (area under the receiver operating characteristic curve [AUC], 0.827 (95% confidence interval [CI], 0.783–0.872), internal validation dataset (AUC, 0.793 [95% CI, 0.714–0.872]), and external validation dataset (AUC, 0.756 [95% CI, 0.658–0.854]). The calibration curves showed good agreement between the predictions and observations for both internal and external validations. Conclusion: The developed nomogram accurately predicted the operative difficulty of TLH, facilitated pre-operative planning and patient counseling, and optimized surgical training. Further prospective multicenter clinical studies are required to optimize and validate this model.

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“…Moreover, proposed methods to estimate blood loss were various and could suffer from inaccuracies of collection, quantification, and intra and interobserver variability, especially for small quantities. Indeed, it must be noted that included studies focused on normal-size uteri (mean size ranges from 126 to 465 gr) and excluded very large uteri or other complex hysterectomies [ 4 ]. In selected cases, even a small reduction in total blood loss could be considered helpful, and a greater clinical advantage could be obtained by combining different techniques for reducing blood loss, such as ABVS devices and uterine artery closure at the origin [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis

Zorzato,

Ferrari,

Garzon

et al. 2023

Arch Gynecol Obstet

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Purpose To compare conventional bipolar electrosurgery with advanced bipolar vessel sealing (ABVS) devices for total laparoscopic hysterectomy (TLH). Methods A systematic review was conducted by searching Scopus, PubMed/MEDLINE, ScienceDirect, and Cochrane Library from January 1989 to November 2021. We identified all studies comparing ABVS devices with conventional bipolar electrosurgery in TLH and reporting at least one of the following outcomes: total blood loss, total operative time, hospital stay, perioperative complications, or costs. Meta-analysis was conducted with a random effect model reporting pooled mean differences and odds ratios (ORs) with related 95% confidence intervals (CIs). Results Two randomized controlled trials and two retrospective studies encompassing 314 patients were included out of 615 manuscripts. The pooled estimated total blood loss in the ABVS devices group was lower than conventional bipolar electrosurgery of 39 mL (95% CI − 65.8 to − 12.6 mL; p = .004). The use of ABVS devices significantly reduced the total operative time by 8 min (95% CI − 16.7 to − 0.8 min; p = .033). Hospital stay length did not differ between the two groups, and a comparable overall surgical complication rate was observed [OR of 0.9 (95% CI 0.256 – 3.200; p = .878]. Conclusions High-quality evidence comparing ABVS devices with conventional bipolar electrosurgery for TLH is lacking. ABVS devices were associated with reduced total blood loss and operative time; however, observed differences seem clinically irrelevant. Further research is required to clarify the advantages of ABVS devices over conventional bipolar electrosurgery and to identify cases that may benefit more from their use.

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The Large Uterus Classification System: a prospective observational study

Abstract: Objective: To investigate the Large Uterus Classification System (LUCS) ability to predict surgical outcomes and complications in total laparoscopic hysterectomies (TLHs) for large uteri.

Cited by 7 publications

References 21 publications

A Vagino-Laparoscopic Strategy for Hysterectomy of Large Uteri to Ease Surgical Challenges

A Vagino-Laparoscopic Strategy for Hysterectomy of Large Uteri to Ease Surgical Challenges

Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study

Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis

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